E/M Coding Clinic: Medical Decision Making Level Determines Difference Between 99282 and 99283

Why This Topic Matters

Correctly distinguishing among emergency department E/M levels affects coding accuracy, audit preparedness, and reimbursement integrity. The article helps readers understand the general documentation framework used to support selection of the appropriate service level without relying on the premium article for the full scoring detail.

Article Sections

1. Editors note and series context

   Introduces the article as part of a series on emergency department evaluation and management reporting and places the discussion in the broader set of emergency service codes.

2. Using the Medicare process correctly

   Discusses the use of Medicare-based review methods as a reference point for evaluating documentation and describes why organizations may look to carrier guidance.

3. Requirements for history and physical

   Summarizes the broad documentation components associated with the history and examination portions of emergency department evaluation and management services.

4. Meeting the requirements for MDM

   Describes the major elements considered in medical decision-making and the general framework used to assess level of complexity.

5. Calculating risk a challenge

   Addresses the role of risk in determining documentation level and the general types of considerations that may affect assessment.

6. Risk level may bump up code

   Explains that changes in risk can affect level selection and discusses the broader implications for emergency department coding decisions.

7. Level 2, MDM

   Provides a worked illustration of how the documentation elements are assessed together for a lower-level emergency department visit.